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Management of the female anterior cruciate ligament: current concepts
  1. Nicholas Vaudreuil1,
  2. Justin Roe2,
  3. Lucy Salmon2,
  4. Elvire Servien3,
  5. Carola van Eck1
  1. 1 Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2 Department of Orthopedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
  3. 3 Department of Orthopedic Surgery, Lyon North University Hospital, Lyon, France
  1. Correspondence to Dr Carola van Eck, Department of Orthopedic Surgery, Univeristy of Pittsburgh, Pittsburgh, PA 15213, USA; vaneckc{at}


Female athletes represent a unique challenge for sports medicine providers. Care for skeletally mature female athletes requires an understanding of the distinct physiology, risk factors and injury patterns that have been described in this population. Anterior cruciate ligament (ACL) injuries are commonly observed in female athletes, especially in high-risk sports such as soccer, basketball, lacrosse and volleyball. Women have been shown to be at a higher risk for ACL injury compared with their male peers, even competing in the same sport. Several factors must be considered when discussing the increased risk of ACL injuries in women. Anatomic factors and altered landing mechanics alignment contribute to increased forces seen at the ACL. A variety of other factors including altered neuromuscular profiles, hormonal factors and genetic factors may all play a role in increased predisposition towards ACL injury. Prevention strategies for ACL such as proprioceptive training may be helpful, especially for at-risk activities such as landing and cutting drills. Optimal surgical management including graft choice is an area of debate. Postoperatively, return to sport protocols are not well standardised for female athletes. Women have a lower return to sport frequency, and psychological factors such as fear of reinjury are often cited as a predominant factor. Overall, the influence of female gender on ACL injury treatment has been an area of heavy research recently. However, more research is needed to elicit the reasons for physical and psychological differences between men and women in order to clarify optimal postoperative management.

  • ACL / PCL
  • knee
  • sports medicine research

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  • Contributors NV: drafting and revising content. JR, LS and ES: acquisition of data, design of the work and final approval. CvE: interpretation of data, revising content and final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work

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